Download Pediatric Endocrine and Cardiovascular Study Notes and more Study Guides, Projects, Research Pediatrics in PDF only on Docsity!
Ped Exam 3 Study Notes
ENDOCRINE:
● Precocious Puberty (too early): ○ Puberty begins before age 8 in girls and before age 9 in boys ○ Height and weight curve would be earlier than normal ○ Early closure of growth plate resulting in less than normal height for age ○ Labs: ■ Elevated GH - which includes LH and FSH ○ Assessment: ■ Labs ■ Growth percentiles ■ Tanner stage ■ Bone age ○ IDIOPATHIC in girls; PATHOLOGIC in boys ○ Treatment: ■ Stop and reverse onset of puberty ○ Types: ■ Central = most common (90-95%) ● Onset of puberty in usual pattern ● Pituitary switch turns on too early ● Treatment = meds to stop process until age we want it to occur ○ LUPRON: ■ Injections q3 months or 1 month ■ Most puberty signs will reverse ■ On medication until we think puberty would start ■ Missing dose = symptoms will come back ■ Peripheral = ● Some elements of puberty occur but not all- showing out of order as well ● Estrogen and testosterone levels are increasing ● Usually related to problem like tumor ■ Incomplete = ● No progression of puberty
● See something happen and then it reverses itself ○ Ex: one boob grows, other doesn’t, then it retreats ○ Gynecomastia ● Possibly from a random surge of hormones- then quiets down ● Growth Hormone Deficiency (GHD): ○ Weight percentile exceeds height (weight is following normal curve - height falls off grid) ○ Immature facial appearance (baby face) ○ Frontal bossing - frontal bone protrudes out ○ Can affect voice (high pitched), genitals ○ Trunk = looks obese cause height is lacking ○ Labs = low GH ● GCS: ○ Pediatric scale used for children under 5 ○ Normal range is 13- 15 ○ ABNORMAL = UNDER 8, INTUBATE ● PEWS: pediatric early warning score ○ Score above 7 = RRT ○ 4-6 = notifying something ○ 03 = no action ● GLUCOSE LEVELS: ● INSULIN: Type Trade Name Onset Peak Duration
Intermediate NPH insulin (Humulin N; Novolin N) 2-6 hrs. 4-14 hrs. 14-20 hrs. Long acting Insulin Glargine (Lantus) Detemir (Levemir) 1 hr. None or small peak after 10-16 hrs. 20-24 hrs. CARDIOVASCULAR: ● Clues that something is wrong = FEAR ○ F = feeding poorly; uses so much energy, breathing too fast ○ E = energy low; always tired, head bobbing, always napping ○ A = always fussy; grunting, crying ○ R = rapid respirations; low oxygen sat ● Congenital Heart Defect Symptoms: ○ Increased pulse ○ Increased respirations ○ FTT ○ Dyspnea, Orthopnea ○ Fatigue ○ URI ● *MOST FREQUENT SIGN OF CHD: ○ Increased RR first ○ Edema also seen in most dependent part ■ For babies = sacrum, bottom ■ Once walking = legs ● Most frequent complaint from parents of infants with CHD: ○ Child isn’t eating enough, losing weight ○ Insensible loss = breathing so fast that they lose weight ● Little helpful hint = ○ Defect begins with T : Cyanotic ■ blue ○ Defects begin with A : Acyanotic ■ Pink
“Acyanotic” Defects:
● General information: ○ Blood shunts from Left to Right
○ Leading to Increased pulmonary blood flow ○ Absence of cyanosis- skin remains pink ○ Symptoms: ■ Pt is typically asymptomatic ■ Murmur is present with or without symptoms ■ s/s of CHF could be present ■ Can experience fatigue related to increased pulmonary blood flow ○ Treatments: ■ Wait and see… hole can close on own ■ Meds: ● Digoxin and Furosemide ○ Given for heart failure! ○ Working = symptoms are going away ■ Surgery ● Patch to close hole- simple surgery ● Discussed if hole hasn’t closed on its own by 2y.o. ● Usually fixed between 2-5y.o. ● Types: ○ Patent Ductus Arteriosus (PDA): ■ Cause = Ductus Arteriosus doesn’t close at birth ● Ductus Arteriosus = tunnel connecting aorta and pulmonary artery ■ Symptoms = ● Skin remains pink ● s/s of HF ● Can be asymptomatic ■ Treatment = ● Symptomatic at birth - 28d (neonate) ○ Indomethacin or ibuprofen ■ Must be given in NICU setting ■ Medically closes the heart ■ ONLY GIVEN TO NEONATE ● Past 28d (not neonate) ○ Digoxin and Furosemide ● If no response to medication = surgery ○ Atrial Septal Defect (ASD): ■ Cause = foramen ovale fails to close at birth ● Foramen ovale = hole between atria ■ Symptoms = ● Skin remains pink
○ Exhibits signs of HF ○ Treatment: ■ Prostaglandin E
● Not at birth: ● Temporary fix ● Keeps ductus arteriosus open until surgery is possible ○ Found from hearing a murmur or seen on echo ○ Treatment: ■ Surgical fix ● Teen years: ○ Found when symptoms appear upon exercise ○ Trouble breathing, leg cramps, headache ■ Treatment = ● Surgical removal of stenosed area ● Surgical widening of aorta - slice vessel open, puts patch over opening to make vessel larger ● Balloon angioplasty with stent ● Treatment of hypertension = ACE inhibitor
“Cyanotic Defects”
● General information: ○ Blood shunts from Right to Left ○ Leading to decreased pulmonary blood flow ○ Symptoms = ■ Severe Cyanosis ■ Hypoxemia ● Hypoxemia is expected. Baseline O2 might be in 80s ■ Polycythemia ■ Clubbing ■ Hypercyanotic Tet spells ○ Requires surgery and medication ● Tet spell = hyper-cyanotic spell ○ Cause = stimuli, bearing down, crying, anger ○ Baseline cyanosis worsens to bluer than normal ○ Treatment = ■ MUST REVERSE! ■ First = put in position that increases pulmonary blood flow ● Knee-chest position ○ Pushed blood from lower parts of body to pulmonary system ● This can be accomplished by placing them in this position or asking them to squat
● Blood shunts from L to R → increased pulmonary blood flow ■ Stenosis of entrance to pulmonary artery and valve ● Causes blood to be stuck in R side → hypertrophy ■ Right Ventricular Hypertrophy ● Occurs from stenosis of pulmonary artery and valve ■ Overarching Aorta: ● Aorta connects to VSD ● Unoxygenated blood from RV travels into Aorta and into systemic circulation ○ Symptoms = ■ Range r/t severity of shunting of blood into aorta and size of holes ■ Symptomatic at birth: ● Baby presents with cyanosis and distress ■ Known before birth: ● Baby given HF medication ● Scheduled for surgery later on ○ Treatment = ■ Symptomatic at birth: ● Given Prostaglandin E to keep Ductus Arteriosus open in order to send to surgery ● Intubation, NPO, IV fluids, frequent vitals ● Surgery = temporary shunt to allow blood to flow/shift and not congregate ■ Doing well on HF meds: ● Continue meds ● Schedule surgery later on ○ Surgery = stenosis is the big thing that needs to be fixed! ■ Patch to enlarge stenosed pathway from RV to PA ■ Patch to close opening between ventricles ● Hypoplastic Left Heart Syndrome (HLHS) ○ Cause = born with the left side of heart underdeveloped ○ Symptoms = ????? can’t function - would know beforehand ○ Treatment = ■ *** Prostaglandin E ● Need to keep heart open so they can live until immediate surgery is performed ■ SURGERY ● 3 part process ● First surgery is done immediately after birth ■ Parent can decide if they want to let child peacefully die ■ Heart Transplant is best-case scenario
■ HF medications ■ Anticoagulants throughout surgeries ○ SURGERY:
● Potassium Levels: ○ Hyperkalemia can enhance effects of digoxin → toxicity ○ Important to check ● S/S of toxicity:
○ Nausea (reminder that not all children can say this) ○ Vomiting ○ Diarrhea ○ Lethargy ○ Bradycardia HYPOTENSION: ●
Definition of Hypotension by Systolic Blood Pressure and Age
Age Systolic Blood Pressure
Neonates < 60 mm Hg
Infants (1 to 12 months) <70 mm Hg
Children 1 to 10 years (5th BP
percentile)
<70 mm Hg + (age in years x 2) mm Hg
Children > 10 years <90 mm Hg
● Hypotension is a LATE indicator of cardiac decompensation CARDIAC ASSESSMENT REMINDERS: ● APETM ● Apical HR listened to at 4th ICS < 7y.o ● Apical HR listened to at 5th ICS > 7y.o. ● Indicators of Cardiac Dysfunction: ○ Poor feeding ○ tachypnea/tachycardia ○ FTT/poor weight gain/activity intolerance ○ Developmental delays ○ Thrills, Heaves ○ Prenatal history: ■ Rubella ■ Alcoholism ■ DM ■ Lupus ■ Advanced maternal age ■ Teratogenic meds ○ Dysrhythmias: ■ Bradycardia ■ Tachycardia
■ Normal sinus arrhythmia ● 5 Lead Placement: ○ RL = right leg (placed on R lower abdomen) ○ LL = left leg (placed on L lower abdomen) ○ RA = right arm (placed under the R clavicle MCL) ○ LA = left arm (placed under the L clavicle MCL) ○ V1 = ventricular lead (placed at 4th ICS right sternal border) ● 3 Lead Placement: ○ RA = right arm (placed under R clavicle MCL) ○ LA = left arm (placed under L clavicle MCL) ○ LL = left leg (placed on the left lower abdomen)
HYPOKALEMIA:
● Foods to give that are high in potassium ○ Potatoes, Pork ○ Oranges ○ Tomatoes ○ Avocados ○ Strawberries ○ Spinach ○ Fish ○ Mushrooms ○ Musk melons - cantaloupe INFECTIOUS AND INFLAMMATORY CARDIAC DISORDERS ● Rheumatic Fever: ○ Inflammatory heart condition occurring post pharyngitis (strep) ■ Strep can spread → valve damage ○ JONES CRITERIA: need 2 major OR 1 major and 2 minor for diagnosis ■ Need positive throat culture or ASO titer ■ Major Criteria: ● Chorea ○ Tick/involuntary movements ○ Sticks around for long time ● Carditis ○ Inflammation of the heart muscle ○ Can lead to valve damage (aortic and mitral valves) ○ Assessment: ■ Murmur or friction rub ■ Echocardiogram
■ Chest pain, may see signs of HF ○ Seen early on; short lived ● Erythema Marginatum
● Sores, cracked lips, bleeding ● Strawberry tongue ○ Treatment = ■ Phases
● Acute phase = high fever for 5+ days ● Sub-acute phase = fever subsides and onset of other symptoms arise ● Convalescence = abnormal labs linger (elevated SED rate, C-reactive protein/CRP) thrombocytosis (high level of platelets) ■ MEDS ● IVIG: one dose ○ Given and checked like a blood product; many vitals and assessing ○ Given over 8-12 hrs ○ Usually subsides the fever right away ● High dose Aspirin = 80-100mg/kg/day ○ Given until fever goes away ● Low dose Aspirin = 3-5 mg/kg/day ○ Given when fever is gone ○ For antiplatelet use ● * no ibuprofen ■ COMFORT: ● Ice pops, magic mouthwash for mouth ● Lotion for skin ● Chapstick or something for lips ● Cluster care ■ Telemetry!!! ■ Echocardiogram ■ Notes = ● aspirin is ototoxic ● Pt cannot receive other meds with aspirin in it ● Multisystem Inflammatory Syndrome-COVID (MIS-C) ○ Patients must be <21y.o. ○ Symptoms = ■ Must present with: ● Fever ● Elevated ESR & CRP ● Shows >= 2 organ involvement ● +covid now, exposure, or +covid within 4 weeks ■ Labs: ● Elevated troponin ● BNP elevation ● Elevated CRP ● Elevated ESR ○ Treatment =
